ENT/Optho Flashcards
When should an infant first see the dentist?
Within 6 months of their 1st tooth or no later than 12 months old
How should the first teeth in infants be cared for?
First teeth appear usually @ 6 months
- Clean at least OD, ideally before bedtime
- Soft toothbrush for babies
- NO toothpaste (not until 2 years old)
When can children start using toothpaste?
2 years of age (unless otherwise directed by dentistry)
What is the most effective test for amblyopia?
Amblyopia: reduced vision in absence of ocular disease when brain doesn’t recognize input from eye
Visual acuity
At what age do infants develop following faces?
birth to 4 weeks
What age do children have visual acuity with appropriate chart?
3.5 years
What eye movement is decreased with a CN 6 nerve palsy?
Decreased abduction of the eyes/decreased lateral gaze
What is the most common suppurative complication of AOM?
Mastoiditis
What are the two most common bacteria implicated in mastoiditis?
S. pneumoniae, S. pyogense
-H. infleunzae & S. aureus are less common
What are the potential intracranial complications associated with mastoiditis?
- Meningitis
- Temporal lobe or cerebellar abscess
- Epidural or subdural abscess
- Venous sinus thrombosis
What are the risks of N. gonorrhea ophthalmia neonatorum?
Corneal ulceration, globe perforation, permanent visual impairment
True or False. The CPS recommends routine prophylaxis for N. Gonorrhea ophthalmia neonatorum.
False. Recommended to NOT routinely prophylax but if mandated, consider 0.5% erythromycin.
How do you manage an infant who was exposed to a mother with N. gonorrhea during delivery?
- Conjunctival swab to be sent for culture for N. gonorrhea
- CTX 50mg/kg IM x1
- If unwell do FSWU
What is the most common cause of sensorineural hearing loss?
Genetic
What is the most common non-genetic cause of sensorineural hearing loss?
CMV
A 10 year old female presents with B/L visual loss, H/A and pain with EOM. An afferent pupillary defect is noted on exam. You are suspicious of the diagnosis of optic neuritis. What disease is she at risk of developing?
MS
A boy presents with a history of 1 week of sore throat, now he is having difficulty opening his mouth and has dysphonia. What is the most likely diagnosis?
Peritonsilar abscess
A child presents with unilateral eye watering and conjunctivitis. On exam, there are periauricular LNs noted. What is the likely diagnosis?
Viral conjunctivitis
-Presents in adolescent/adults
-Mostly during summer
-Watery discharge, unilateral, assoc. w/ periauricular nodes
Adenovirus: may present with pharyngitis or PNA
Enterovirus: may present as an epidemic
Mgt: supportive
A child has bilateral vocal cord paresis. What test do you need to do?
MRI head
DDx: Arnold Chiari malformation, posterior fossa tumor, meningomyelocele, cerebral agenesis, hydrocephalus
What is on the DDx for leukocoria?
- Cataract
- Retinoblastoma
- Retinopathy of prematurity
- Retinal detachment
- Retinoschisis
What is a ranula and what is the treatment?
Ranula: pseudocyst assoc. w/ the sublingual glands and submandibular ducts
Management: excision of sublingual gland
What is the order of development of the sinuses?
My Extremely Smelly Friend
Maxillary: present @ birth, radiologic @ 4-5 months
Ethmoid: present @ birth, radiologic @ 1 year
Sphenoid: not present @ birth, develops first 2 yrs, radiologic @ 4 years
Frontal: not present @ birth, size increases to teen yrs, radiologic @ 6 years
What other anatomical anomaly do you need to consider if you visualize a bifid uvula?
Submucous cleft
-Bifid uvula may be a sign of submucous cleft, which occurs when the palate mucosa is intact but underlying palatal musculature is dehiscent
When do you refer for ear tubes?
- Recurrent AOM w/ middle ear effusion
- B/L OM w/effusion (>3m) w/ conductive hearing loss
- Unilat/Bilat OME (>3m) w/ other problems (behaviour, pain, balance etc.)
- Uncommonly: complications of AOM (mastoiditis), lack of response to medical tx, chronic retraction of TM
A child presents with nasal trauma. What must you rule out on physical exam?
Rule out septal hematoma - this needs emergent drainage as it can cause dissolution of the cartilage. Also, note that it can present later if someone comes back a few days later with extreme pain and fever = hematoma has now abscessed.
A 13 year old M presents with severe chronic unilateral epistaxis. Labs are all normal. What is your next step in management?
A. Repeat coags
B. Transfuse prophylactically
C. Refer to ENT for endoscopy/possible imaging
D. Start on nasal steroids
C. Refere to ENT for endoscopy/imaging
-Looking for Juvenile Nasal Angiofibroma
What is the management for TM perforation?
- Most heal within 6 weeks
- Otic drops (ciprodex)
- Repair @ 9-10yrs
- Referral if otorrhea is persistent/perforation visible
What are the absolute indications for adenotonsillectomy?
-OSA (AHI>5/hr) and large tonsils
-Cor pulmonale
-Suspected malignancy
-Hemorrhagic tonsillitis
-Severe dysphagia
(Recurrent tonsillitis is a relative indication)
What are the two most common congenital neck masses in children?
Branchial cleft cyst and thyroglossal duct cyst
